Individual
MR. SRINIVAS MIRYANAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1600 LIBERTY ST, COVINGTON, IN 47932-1715
(765) 793-4818
Mailing address
2320 N VERMILION ST, APT 322, DANVILLE, IL 61832-1739
(205) 381-1997
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010247A
IN
225100000X
Physical Therapist
5501015050
MI
Other
Enumeration date
06/02/2010
Last updated
06/02/2010
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